June 2015
Welcome to WISHIN Connections, the monthly e-Newsletter from the Wisconsin Statewide Health Information Network (WISHIN).  We will keep you up to date with WISHIN activities, news on health information exchange (HIE) and new product developments.

WISHIN Participates in the eHealth Exchange- 
So You Don't Have to

By Jean Doeringsfeld, Chief Operating Officer

Becoming an eHealth Exchange participant takes some work - and requires more than a few resources.  It means signing a legal agreement, completing testing to show compliance with technical standards, and paying an initial fee and ongoing annual fees. 


The good news is that WISHIN Pulse participants can skip all of the legal, technical, and financial requirements for onboarding directly to the eHealth Exchange because WISHIN has already done that work for you.  WISHIN's participation in the eHealth Exchange extends to all of our WISHIN Pulse participants; your organization does not need to onboard to the eHealth Exchange directly in order to reap the benefits. 


Participation in the eHealth Exchange is important for purposes of Meaningful Use (MU) compliance.  Under MU, care summaries must be electronically shared via Direct Secure Messaging (e.g., WISHIN Direct+) or through an organization that is a participant in the eHealth Exchange. 


It's been about a year since WISHIN became an official participant in the eHealth Exchange so we thought it might be time to provide a brief update on what that means for WISHIN participants.


You may recall that the eHealth Exchange is a network of providers, hospitals, HIEs (like WISHIN), federal agencies, etc., that share clinical information (care summaries) using a secure, standardized approach.  There are currently more than 90 participants spanning all 50 states that share information via the eHealth Exchange. Basically, you can think of it as the national highway for electronically sharing health information.


At a practical level, WISHIN's participation in the eHealth Exchange provides some key benefits to WISHIN Pulse participants, including:


1. Automatically Query the eHealth Exchange
When you query WISHIN Pulse for clinical data (care summaries) on your patient from within your EHR, you are automatically querying all WISHIN Pulse participants AND all eHealth Exchange participants that WISHIN has configured.  You don't have to know the specific organization you want it to query.  You just point it to WISHIN and the rest is done for you.  WISHIN won't query 
every eHealth Exchange participant (that's against the rules) - but we will query key participants in our border states, other state HIEs, participants that commonly share patients with WISHIN participants, and participants in our snowbird states like Florida and Arizona.  Who WISHIN queries on the eHealth Exchange is configurable - so we can add to it easily and quickly at any time.


And don't worry.  Even though we query all those eHealth Exchange participants, you'll only get responses from those that have care summaries on your patient.  So if your patient has never received care from an eHealth Exchange participant, the query will return data only from other WISHIN participants.  But if they did, WISHIN Pulse will show you that data too.

We've received some questions on this, so to make sure we're giving you complete and accurate information:  When you query WISHIN from your EHR, it does not require you to know which WISHIN participant OR which eHealth Exchange participant your patient received care from in order to perform the query and provide you with the clinical data you need.  Some systems do; we know.  But that's not us.  All you need to do is query WISHIN.  We take care of the rest. 

One other point that bears noting, the eHealth Exchange is a gateway for sharing care summaries only.  So while WISHIN Pulse can provide other types of clinical data (EKGs, radiology reports, lab results, etc.) the eHealth Exchange only supports the exchange of care summaries, which may include those kinds of data, but are not guaranteed to do so.  Don't get us wrong - care summaries are wealth of valuable clinical information so it's important that you can get them. We just want to make sure it's clear what you're getting. 



2. SSA Disability Determination 
Next year, WISHIN's eHealth Exchange participation will allow the Social Security Administration (SSA) to query WISHIN Pulse participants in order to get the clinical data (in the form of care summaries) necessary for disability determination.  According to the SSA, its ability to get the care summaries electronically significantly reduces the amount of time it takes to get a determination on disability - from weeks and months in the current paper-based process, down to hours and days via HIE!

A faster turnaround on disability determination can mean that coverage becomes effective sooner, which can help avoid delays in care that can result in more serious conditions requiring more expensive treatments.  It also means your claims can be processed sooner. 

WISHIN has been meeting with the SSA and is currently working through some of the additional testing that is required to ensure the patient has consented to the SSA receiving their clinical data (remember, the SSA isn't a covered entity under HIPAA, so a patient must consent in order for us to give the SSA the patient's health information). 

WISHIN is an early adopter of the SSA functionality. According to the eHealth Exchange website, there are currently only three other eHealth Exchange participants that are "SSA responders" today.  So, while we aren't the first, we will be one of the first to get this functionality up and running and offered to our participants.


The SSA functionality only works with care summaries.  This means that WISHIN participants must be sharing care summaries with the WISHIN Pulse network in order to use it.  The process of sharing care summaries to WISHIN Pulse takes several months.  If you're a WISHIN Pulse participant and you know you're going to want to take advantage of the SSA disability determination functionality, you should contact your WISHIN project manager right away.  We can get you started onboarding your care summaries now and avoid any delay once the SSA functionality is live.

The care summaries required by the SSA for disability determination are the standard CCDA care summaries supported by all EHRs with 2014 Certified Electronic Health Record Technology (aka 2014 CEHRT). This means that if you're participating in Stage 2 of the Meaningful Use Incentive Program and you're using a 2014 CEHRT EHR, the care summaries produced out of your EHR are already exactly what the SSA needs to do disability determination.   There's no extra data needed in them.  There's no special format.  Nothing different.  And while your EHR vendor may tell you that they have something "special" or "custom" that the SSA likes; it simply isn't necessary or required. The SSA expects the same thing from every EHR; they don't change their requirements EHR vendor by EHR vendor.   And yes, we've confirmed that directly with the SSA.

That said, if your EHR isn't 2014 CEHRT, WISHIN may have to work with you and your EHR vendor to get the care summaries in the correct format - but that's ok, we can do that too!

One last thing on this topic, and it's important:  The SSA is paying WISHIN for every care summary they use via this functionality and WISHIN will be sharing this revenue with WISHIN participants that enable this service.  This means that in addition to the savings you'll realize by not having to process the SSA requests manually, you'll also be receiving payment for the care summaries you provide to them through WISHIN Pulse. We haven't worked through all the details yet with the SSA on this - but as soon as we do, we will make the information available to you.


3. Veteran's Administration Access
WISHIN's eHealth Exchange participation will also allow WISHIN Pulse participants to exchange health information with the Veterans Administration (and other providers).  Many veterans see VA and non-VA health care providers, which can make it difficult for providers to access the records they need to manage a veteran's care.  The VLER (Virtual Lifetime Electronic Record) Health Exchange allows non-VA providers to securely view certain veteran health information through the eHealth Exchange. 

If you're a WISHIN Participant and you treat veterans, this functionality will give you access to care summary information from the VA and from non-VA providers.

The VA is expected to support care summaries in the CCDA format this summer (it currently only supports the C32 format).  Once that happens, WISHIN will be able to finalize the process with the VA and use our eHealth Exchange participation for exchanging Veteran health information with VA and non-VA providers.  If everything goes as planned, we expect this to be available by the end of the year.


4. Meaningful Use: Transitions of Care 
As a WISHIN Pulse participant, your organization can also meet the Meaningful Use Transitions of Care objective by sharing your care summaries via WISHIN Pulse.  While many of you may be sharing care summaries using Direct secure messaging or through your EHR vendor's proprietary solution, as noted above, the objective can also be met by participating in a health information exchange - as long as that HIE is an eHealth Exchange participant like WISHIN is with WISHIN Pulse. 


In Stage 3 of Meaningful Use (as currently proposed), the requirements for transitions of care are increased.  Each eligible provider, hospital, or Critical Access Hospital will need to determine if the mechanisms they are currently using to meet the Stage 2 objective will be sufficient to meet the requirements for Stage 3, or if additional mechanisms may be needed.  If you are already a WISHIN Pulse participant, onboarding your care summaries to WISHIN Pulse may be all you need to satisfy the new measures.

All of the benefits noted in this article are (or will be) available to WISHIN Pulse participants without the need to onboard separately or directly to the eHealth Exchange.  If you have questions, or would like more information, contact us directly at (608) 274-1820.


Wisconsin Statewide Health Information Network | 608-274-1820 [email protected] | http://www.wishin.org
PO Box 259038
Madison, WI 53725-9038